Provider Demographics
NPI:1538463898
Name:CUNNINGHAM CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:CUNNINGHAM CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-635-5658
Mailing Address - Street 1:8827 N GOVERNMENT WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8231
Mailing Address - Country:US
Mailing Address - Phone:208-635-5658
Mailing Address - Fax:208-635-5659
Practice Address - Street 1:8827 N GOVERNMENT WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8231
Practice Address - Country:US
Practice Address - Phone:208-635-5658
Practice Address - Fax:208-635-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1428111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty